Secure cryosurgical treatment system

ABSTRACT

A method for cryogenically treating tissue. A connection is detected between a probe having a disposable secure processor (DSP) to a handpiece having a master control unit (MCU) and a handpiece secure processor (HSP), the probe having at least one cryogenic treatment applicator. The probe is fluidly coupled to a closed coolant supply system within the handpiece via the connection. An authentication process is initiated between the DSP and the HSP using the MCU. As a result of the authentication process, one of at least two predetermined results is determined, the at least two predetermined results being that the probe is authorized and non-authorized.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/900,345, filed Nov. 5, 2013, which is incorporated by referenceherein.

BACKGROUND OF THE INVENTION

Medical devices can include a handpiece for operational control of adetachable tip used for applying a therapy, such as electrocautery orcryogenic therapy. In many instances, the detachable tip is designed andapproved for a single use, or a limited amount of uses, and should bedisposed afterwards. For example, a detachable tip can have a very finecryogenic needle that dulls after use, and thus rendered unable topierce tissue in an intended manner. In other cases, the detachable tipcannot be safely sterilized after use.

Unfortunately, some users reuse detachable tips in spite of thesedangers. This can cause problems such as patient injury or infection.Additionally, fraudsters may produce duplicate tips withoutauthorization. These duplicate tips can be unsafe because of faultyconstruction or sterilization methods, since manufacture is unregulated.Accordingly, there is a need to address these issues.

BRIEF SUMMARY OF THE INVENTION

Embodiments of the invention can include a therapy system having adisposable device and a durable device. Each device can include a securemicroprocessor with applications code and configuration data.

In some embodiments, one secure processor can be located in thehandheld/durable device, such a cryogenic therapy device, and the othersecure processor can be located in a disposable/consumable device (e.g.a detachable probe with at least one cryogenic needle), which is adaptedto receive cryogenic cooling fluid from the handheld device, interfacewith tissue to provide direct therapy to a patient, and mechanicallycouple and decouple with the handheld device.

In some embodiments, the handheld device can include a microprocessorcontrol unit (MCU) with software applications code, communication linksand related electronic circuitry. The secure processor (HSP) in thehandheld device contains custom software and configuration data, and mayinclude one or more X509 digital certificates. The secure processor inthe disposable device (DSP) can also contain custom software andconfiguration data, including one or more ITU-T X509 (ISO/IEC 9594-8)digital certificates. Such configuration data can include apredetermined amount of treatment cycles, treatment cycle parameters,tip identification, and performance test parameters.

In some embodiments, the two secure processors can communicate with oneanother by way of electronic circuitry of the MCU. Software in the MCUand the secure processors implements communication protocols, includingcommands and replies. The software contains logic to perform anauthentication according to a protocol, such as public keyinfrastructure (PKI)-based authentication, between the durable andconsumable patient treatment devices. This software uses cryptographictechniques to establish trusted identity and secure communication.

In some embodiments, the disposable device can be authenticated usingPKI signing challenge methods issued by the HSP. The DSP may refuse arequest to provide the application configuration data if authenticationhas not been completed. This feature, optionally in conjunction with adesign in which the handpiece or disposable device requires thisexternal data for operation, provides a way of denying use of the systemin cases where trust has not been established that the disposable deviceis authentic. The authentication method may be extended to two-wayauthentication. Accordingly, one or more disposable device componentsauthenticate one or more handheld device components in addition to theauthentication processes initiated by the one or more durablecomponents. In some embodiments, the disposable device may authenticatethe handpiece in a one-way authentication process.

In some embodiments, the authentication method can be extended to covermultiple types of disposable devices (e.g., pain treatment needles,cosmetic needles, etc.). This design alternative could enforce anelectronic manifest, configured in the disposable device, which wouldauthenticate the set(s) of disposable devices.

In some embodiments, interprocessor communication devices and protocolsmay be used including I2C, SPI, serial, or ISO7816.

In some embodiments, the disposable device and handheld device cancommunicate wirelessly. The use of wireless communication betweendisposable and durable components will support a product architecturewhere the components are not directly connected.

In some embodiments, the MCU can connect to a remote authorizationservice. In this embodiment, the disposable device and/or handpiece isauthenticated remotely. The authenticated device can then provide one ormore communications channels for one or more disposable components,which in turn are authenticated.

In some embodiments, a network of trust is created across a plurality ofdurable and disposable components.

Embodiments include a system with a probe having at least one cryogenictreatment applicator and a disposable secure processor (DSP), ahandpiece removeably coupled to the probe and configured to providecryogen coolant from a coolant supply system to the probe, the handpiecehaving a microprocessor control unit (MCU) and a handpieceauthentication processor (HSP).

Embodiments also include a method for operating the system. The methodincludes detecting connection of the probe to the handpiece andinitiating an authentication process between the DSP and HSP using theMCU as a communications router. As a result of the authenticationprocess, determining one of at least two predetermined results, the atleast two predetermined results comprising that the probe is authorizedand non-authorized.

In some embodiments, the authentication process comprises the HSPrequesting a certificate from the DSP.

In some embodiments, the authentication process comprises requesting acertificate from the DSP; validating the certificate; creating a nonce;encrypting the nonce with the public key in the certificate; sending arequest to the DSP to decrypt the nonce using a private key; receivingthe decrypted nonce from the DSP; and verifying the decrypted nonce.

In some embodiments, the probe is authorized after the DSP completes asigning challenge or non-authorized after the DSP fails the signingchallenge.

In some embodiments, the signing challenge comprises the HSP requestinga certificate from the DSP.

In some embodiments, the DSP returns the digital certificate to the HSPas part of the signing challenge.

In some embodiments, the HSP validates the authenticity of the digitalcertificate by using one or more stored digital certificates issued byan authority.

In some embodiments, the HSP uses a public cryptographic key containedin the certificate provided by the DSP to encrypt a nonce.

In some embodiments, the HSP transmits the nonce to the DSP and requestsa decrypted reply.

In some embodiments, the DSP uses a private cryptographic key associatedwith the public cryptographic key, contained in the digital certificatepreviously transmitted, to decrypt the encrypted nonce.

In some embodiments, the HSP compares the decrypted nonce with thepreviously transmitted challenge nonce.

In some embodiments, the probe is authenticated when the HSPsuccessfully matches the sent nonce with the decrypted nonce, ornon-authorized if: the decrypted nonce does not match the sent nonce orif the DSP fails to reply to the certificate request or the decryptrequest.

In some embodiments, as a result of the authentication process the probeis determined to be authorized.

In some embodiments, the method also includes accessing recorded historysettings of the DSP and based on the history settings, determining oneof: that the probe is expired and non-expired.

In some embodiments, based on the recorded history settings, the probeis determined to be non-expired.

In some embodiments, as a result that the probe is determined to benon-expired, data is retrieved from the DSP containing proceduralinstructions for the MCU for operating the probe.

In some embodiments, the data comprises a tip descriptor that includesidentification, treatment cycle and system control parameters, and testsettings. The tip descriptor is used by the MCU to control the systemfor testing the probe and performing treatment cycles. The DSP firmwarecan include one or more X.509 certificates and an expiration descriptor.The expiration descriptor can include a version type, allowed cycles,total minutes of validity from first use, and a list of handpiece typeswhich are compatible with the probe.

In some embodiments, a request is sent to the DSP to check the allowedremaining uses of the probe.

In some embodiments, after receiving the request the DSP determines theremaining allowable uses of the probe and provides the MCU with one of:an indication that the probe has no remaining uses available and anindication that the probe can be used.

In some embodiments, the DSP provides the MCU with the indication thatthe probe can be used and increments a use-counter of the probe.

In some embodiments, based on the history settings, the probe isdetermined to be expired.

In some embodiments, as a result of the authentication process the probeis determined to be non-authorized for use.

In some embodiments, a user alert is transmitted using the MCUindicating that the probe is not useable with the handpiece.

In some embodiments, each secure processor includes one or more digitalcertificates and the authentication process comprises performing acryptographic signing challenge algorithm.

In some embodiments, communication between the secure processors isencrypted during the authentication process.

In some embodiments, the probe is authorized and as a result the MCUindicates to the user that the system is ready to perform a treatmentcycle.

In some embodiments, after the probe is authorized and the userinitiates the treatment cycle, the MCU sends the start request to theDSP.

In some embodiments, the DSP processes the treatment start request bydetermining the remaining authorized uses, decrementing the remaininguses, and returning a reply which indicates either the treatment isauthorized or the probe is expired.

In some embodiments, the MCU uses the reply from the DSP to either begina treatment cycle or indicate to the operator that the probe is expired.

Some embodiments include a cryogenic handpiece operable by amicroprocessor control unit. A probe is removeably coupled to thehandpiece, configured to receive coolant from the handpiece, and has aprocessor communicatively coupled to the microprocessor control unit.The processor includes operating instructions for execution by themicroprocessor to control metering of the coolant to the probe.

Some embodiments include a cryogenic probe with a body having at leastone cryogenic treatment applicator fluidly connectable to a separatecoolant supply device for providing power, data, and/or coolant to theat least one cryogenic treatment applicator. The cryogenic probeincludes an integrated circuit storing a tip descriptor

In some embodiments, the integrated circuit is a processor.

In some embodiments, the integrated circuit comprises memory for storingthe tip descriptor.

In some embodiments, the tip descriptor includes a protocol for timingopening and closing of the controllable valve.

In some embodiments, the body comprises a heater and wherein the tipdescriptor includes heater control parameters.

In some embodiments, the tip descriptor includes a target heatertemperature.

In some embodiments, the tip descriptor includes test parameters.

In some embodiments, the tip descriptor includes expiration information.

In some embodiments, the tip descriptor comprises instructionalparameters for operating the separate coolant supply device.

In some embodiments, the at least one cryogenic treatment applicatorcomprises a sharpened or round needle

Some embodiments include a kit of cryogenic probes with a plurality ofcryogenic probes, each cryogenic probe having a body with at least onecryogenic treatment applicator with connections for coolant, power, anddata to a separate device for providing coolant, power, and data to theat least one cryogenic treatment applicator. In some embodiments, atleast one of the cryogenic probes includes a secure processor comprisingmemory having instructional parameters for operating coolant supplydevice with the remaining plurality. In other embodiments, eachcryogenic probe can share the same type of treatment applicatorconfiguration, but different instructional parameters.

In some embodiments, a treatment system and method implement differenttypes of probes. These probes are different only with respect to the tipdescriptors stored within. Accordingly, a first type of probe can have aspecific needle configuration, while the second type of probe shares thesame needle configuration. The different tip descriptors, however,contain or identify different types of treatment protocols. For example,the first type of probe is indicated for use on a specific nerve, orparticular location within a nerve cluster, requiring a certain coolingcurve (temperature vs. time). While the second type of probe isindicated for use on a different nerve, or a different location withinthe same nerve cluster, requiring a different cooling curve (e.g.,colder, less cold, shorter dwell time, etc.).

Some embodiments include a method for cryogenically treating tissue. Inthe method, a connection is detected of a first type of probe having afirst processor to a handpiece having a master control unit (MCU). Thehandpiece is compatible with a plurality of different types of probes.The first type of probe has at least one cryogenic treatment applicator,and is fluidly coupled to a closed coolant supply system within thehandpiece via the connection. A communication process is then initiatedbetween the first processor and the MCU, during which the firstprocessor provides a first type of tip descriptor to the MCU. As aresult of the communication process, a first type of treatment protocolis initiated based on the first type of tip descriptor. Some embodimentsalso include a system for cryogenically treating tissue. The systemincludes a first type of probe having a first processor and memorystoring a first type of tip descriptor. The first type of probe has atleast one cryogenic treatment applicator. A handpiece has a mastercontrol unit (MCU) and is compatible with a plurality of different typesof probes. The first type of probe is fluidly couplable to a closedcoolant supply system within the handpiece. The first processor isconfigured to communicate the first type of tip descriptor to the MCU.The MCU is configured to implement a first type of treatment protocolbased on the first type of tip descriptor.

In some embodiments, the first type of treatment protocol is provided bythe tip descriptor.

In some embodiments, the treatment protocol is retrieved from memory ofthe handpiece by the MCU based on identification of the tip descriptor.

In some embodiments, the plurality of different types of probes sharethe same type of cryogenic treatment applicator configuration.

In some embodiments, the first type of treatment protocol is provided bythe first type of tip descriptor.

Some embodiments include a system for cryogenically treating tissue. Thesystem includes a first type of probe having a first processor and firstmemory storing a first type of tip descriptor. The first type of probehas at least one of cryogenic treatment applicator configuration. Thesystem also includes a second type of probe having a second processorand second memory storing a second type of tip descriptor. The secondtype of probe shares the same type of cryogenic treatment applicatorconfiguration as the first type of probe. The system also includes ahandpiece having a master control unit (MCU). The handpiece iscompatible with a plurality of different types of probes. The first andsecond type of probe are each fluidly couplable in sequence to a closedcoolant supply system within the handpiece. The first processor isconfigured to communicate the first type of tip descriptor to the MCU,and the second processor is configured to communicate the second type oftip descriptor to the MCU. The MCU is configured to implement a firsttype of treatment protocol based on the first type of tip descriptor,and a second type of treatment protocol based on the second type of tipdescriptor. In some embodiments, the first type of treatment protocolrelates to a first type of nerve, while the second type of treatmentprotocol relates to a second type of nerve.

Some embodiments include a method for cryogenically treating tissue. Inthe method, a first connection is detected of a first type of probehaving a first processor to a handpiece having a master control unit(MCU). The handpiece is compatible with a plurality of different typesof probes. The first type of probe has at least one cryogenic treatmentapplicator. The first type of probe is fluidly coupled to a closedcoolant supply system within the handpiece via the first connection. Afirst communication process is imitated between the first processor andthe MCU, in which the first processor provides a tip descriptor to theMCU, with the tip descriptor being specific to the first type of probe.As a result of the first communication process, a first type oftreatment protocol is initiated based on the first type of tipdescriptor. A second connection is detected of a second type of probe,having a second processor, to the handpiece after the first type ofprobe is decoupled from the handpiece. The second type of probe sharesthe same type of cryogenic treatment applicator configuration as thefirst type of probe. The second type of probe is fluidly coupled to theclosed coolant supply system within the handpiece via the secondconnection. A second communication process is initiated between thesecond processor and the MCU, during which the second processor providesa second type of tip descriptor to the MCU. As a result of the secondcommunication process, a second type of treatment protocol isimplemented based on the second type of tip descriptor. The second typeof treatment protocol is different from the first type of treatmentprotocol. In some embodiments, the first type of treatment protocolrelates to a first type of nerve or a particular nerve location, whilethe second type of treatment protocol relates to a second type of nerveor a different nerve location.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective view of a security enabled subdermal cryogenicsystem, according to some embodiments.

FIG. 1B is a partially transparent perspective view of the cryogenicsystem of FIG. 1A, showing additional internal components of thecryogenic system and schematically illustrating secured replacementtreatment needles for use with the disposable probe, according to someembodiments.

FIG. 2A schematically illustrates components that may be included in thetreatment system of FIG. 1A, according to some embodiments.

FIG. 2B illustrates a security communication architecture that may beincluded in the treatment system of FIG. 1A, according to someembodiments.

FIG. 3A illustrates a sequence diagram for an operational method foroperating the treatment system of FIG. 1A, according to someembodiments.

FIGS. 3B and 3C illustrates a flow chart for an operational method foroperating the treatment system of FIG. 1A, according to someembodiments.

FIG. 3D illustrates a sequence diagram for an operational method foroperating the treatment system of FIG. 1A, according to someembodiments.

FIG. 3E illustrates a flow chart for an operational method for operatingthe treatment system of FIG. 1A, according to some embodiments.

FIG. 4 illustrates a flow chart for an operational method for operatingthe treatment system of FIG. 1A, according to some embodiments.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides secured medical devices, systems, andmethods. Embodiments of the invention will facilitate safe treatment oftarget tissues disposed at and below the skin by providing a securesystem that prevents unauthorized use of expired, counterfeit orotherwise unallowed probes.

Among the most immediate applications of related devices may be theamelioration of lines and wrinkles, particularly by treating motornerves to prevent muscular contractions that are associated with thesecosmetic defects so as to improve an appearance of the patient.Additional applications include the treatment of pain in which sensorynerves are treated to prevent the sensation of pain at a particularportion of the body. Additional description of cryogenic cooling fortreatment of defects may be found in commonly assigned U.S. Pat. No.7,713,266 entitled “Subdermal Cryogenic Remodeling of Muscle, Nerves,Connective Tissue, and/or Adipose Tissue (Fat)”, U.S. Pat. No. 7,850,683entitled “Subdermal Cryogenic Remodeling of Muscles, Nerves, ConnectiveTissue, and/or Adipose Tissue (Fat)”, and U.S. patent application Ser.No. 13/325,004, entitled “Method for Reducing Hyperdynamic FacialWrinkles”, U.S. Pub. No. 2009/0248001 entitled “Pain Management UsingCryogenic Remodeling” the full disclosures of which are eachincorporated by reference.

Referring now to FIGS. 1A and 1B, a system for cryogenic treatment herecomprises a hand held device generally having a proximal end 12 and adistal end 14. A handpiece body or handpiece 16 has a size and ergonomicshape suitable for being grasped and supported in a surgeon's hand orother system operator. As can be seen most clearly in FIG. 1B, acryogenic cooling fluid supply 18, a supply valve 32 and electricalpower source 20 are found within a handpiece 16, along with a circuithaving a microprocessor control unit (MCU) 22 that typically comprises aprocessor for controlling cooling applied by self-contained system 10 inresponse to actuation of an input 24. Alternatively, electrical powercan be applied through a cord from a remote power source. The powersource 20 also supplies power to heater element 44 in order to heat theproximal region of the probe 26 thereby helping to prevent unwanted skindamage, and a temperature sensor 48 adjacent the proximal region of theprobe 26 helps monitor probe temperature. When actuated, the supplyvalve 32 controls the flow of cryogenic cooling fluid from the coolingfluid supply 18.

A handpiece secure processor (HSP) 23 (schematically shown in FIG. 2A)is electrically connected to the MCU 22. A secure processor, also knownin the art as a secure cryptoprocessor, is a dedicated computer on achip or microprocessor for carrying out cryptographic operations andstoring data. A secure processor is embedded in packaging with multiplephysical security measures that provide the secure processor with tamperresistance.

Extending distally from the distal end 14 of the handpiece 16 is adetachable cryogenic cooling probe 26. The probe 26 is coupled to acooling fluid path extending from a cooling fluid source 18, with theexemplary probe comprising a tubular body receiving at least a portionof the cooling fluid from the cooling fluid source therein. Theexemplary probe 26 can include a 27 g needle having a proximal end thatis axially sealed. It should be understood that any reference to“needle” herein is meant in a generic sense and refers to any cryogenictreatment applicator and e.g. can comprise an elongated shape, such as asharpened needle usable for piercing tissue or a rounded or bluntedneedle that is separately introduced into tissue (e.g. via a cannula)and used for blunt probing/dissection of tissue. The probe 26 may havean axial length between the distal end 14 of the handpiece 16 and thedistal end of the needle of between about 0.5 mm and 10 cm. Generally,probe 26 will comprise a 16 g or smaller size needle, often comprising a20 g needle or smaller, typically comprising a 22, 25, 26, 27, 28, 29,or 30 g or smaller needle.

In some embodiments, probe 26 may comprise two or more needles arrangedin a linear array, such as those disclosed in previously incorporatedU.S. Pat. No. 7,850,683. Another exemplary embodiment of a probe havingmultiple probe configurations allow the cryogenic treatment to beapplied to a larger or more specific treatment area. Other needleconfigurations that facilitate controlling the depth of needlepenetration and insulated needle embodiments are disclosed in commonlyassigned U.S. Patent Publication No. 2008/0200910 entitled “Replaceableand/or Easily Removable Needle Systems for Dermal and TransdermalCryogenic Remodeling,” and U.S. Provisional Patent Application No.61/801,268 entitled “Cryogenic Blunt Dissection Methods and Devices,”the entire contents of which are incorporated by reference. Multipleneedle arrays may also be arrayed in alternative configurations such asa triangular or square array. Arrays may be designed to treat aparticular region of tissue, or to provide a uniform treatment within aparticular region, or both.

The probe 26 is releasably coupled with the handpiece 16 so that it maybe replaced after use with a new probe (as indicated by the dotted linein FIG. 1B) or with another probe having a different configuration. Inexemplary embodiments, the probe 16 may be threaded into the body, itmay be press fit into an aperture in the body or it may have a quickdisconnect such as a detent mechanism for engaging the probe with thebody. A quick disconnect with a check valve is advantageous since itpermits decoupling of the probe from the body at any time withoutexcessive coolant discharge. This can be a useful safety feature in theevent that the device fails in operation (e.g. valve failure), allowingan operator to disengage the probe from a patient's tissue withoutexposing the patient to coolant as the system depressurizes. Thisfeature is also advantageous because it allows an operator to easilyexchange an expired or dulled needle with a new needle in the middle ofa treatment. One of skill in the art will appreciate that other couplingmechanisms may be used.

In addition to the coolant connection, the probe/handpiece connectionprovides electrical connections for power, sensor readings, and datacommunications. These electrical connections may take the form ofmechanical contacts such as pin and socket connectors or spring contactprobes (commonly referred to as pogo pins) and connection pads.

Addressing some of the components within the handpiece 16, the exemplarycooling fluid supply 18 comprises a canister, sometimes referred toherein as a cartridge, containing a liquid under pressure, with theliquid preferably having a boiling temperature of less than 37° C. Whenthe fluid is thermally coupled to the tissue-penetrating probe 26, andthe probe is positioned within the patient so that an outer surface ofthe probe is adjacent to a target tissue, the heat from the targettissue evaporates at least a portion of the liquid and the enthalpy ofvaporization cools the target tissue. A supply valve 32 may be disposedalong the cooling fluid flow path between a canister 18 and the probe26, or along the cooling fluid path after the probe so as to limitcoolant flow thereby regulating the temperature, treatment time, rate oftemperature change, or other cooling characteristics. The valve 32 willoften be powered electrically via power source 20, per the direction ofMCU 22, but may at least in part be manually powered. The exemplarypower source 20 comprises a rechargeable or single-use battery.Additional details about valve 32 are disclosed below and furtherdisclosure on the power source 20 may be found in commonly assignedInt'l Pub. No. WO 2010/075438 entitled “Integrated Cryosurgical ProbePackage with Fluid Reservoir and Limited Electrical Power Source,” theentire contents of which is incorporated by reference. The exemplarycooling fluid supply 18 comprises a single-use canister. Advantageously,the canister and cooling fluid therein may be stored and/or used at (oreven above) room temperature.

The MCU 22 will typically comprise a programmable electronicmicroprocessor embodying machine readable computer code or programminginstructions for implementing one or more of the treatment methodsdescribed herein. The microprocessor will typically include or becoupled to a memory (such as a non-volatile memory, a flash memory, aread-only memory (“ROM”), a random access memory (“RAM”), or the like)storing the computer code and data to be used thereby, and/or arecording media (including a magnetic recording media such as a harddisk, a floppy disk, or the like; or an optical recording media such asa CD or DVD) may be provided. Suitable interface devices (such asdigital-to-analog or analog-to-digital converters, or the like) andinput/output devices (such as USB or serial I/O ports, wirelesscommunication cards, graphical display cards, and the like) may also beprovided. A wide variety of commercially available or specializedprocessor structures may be used in different embodiments, and suitableprocessors may make use of a wide variety of combinations of hardwareand/or hardware/software combinations. For example, the MCU 22 may beintegrated on a single processor board and may run a single program ormay make use of a plurality of boards running a number of differentprogram modules in a wide variety of alternative distributed dataprocessing or code architectures.

Referring now to FIG. 2A, the flow of cryogenic cooling fluid from fluidsupply 18 is controlled by a supply valve 32. The supply valve 32 maycomprise an electrically actuated solenoid valve, a motor actuated valveor the like operating in response to control signals from the MCU 22 toimplement an authorized treatment algorithm. Exemplary supply valves maycomprise structures suitable for on/off valve operation, and may provideventing of the fluid source and/or the cooling fluid path downstream ofthe valve when cooling flow is halted so as to limit residual cryogenicfluid vaporization and cooling. Additionally, the valve may be actuatedby the MCU 22 in order to modulate coolant flow to provide high rates ofcooling in some instances where it is desirable to promote necrosis oftissue such as in malignant lesions and the like or slow cooling whichpromotes ice formation between cells rather than within cells whennecrosis is not desired. More complex flow modulating valve structuresmight also be used in other embodiments. For example, other applicablevalve embodiments are disclosed in previously incorporated U.S. Pub. No.2008/0200910.

Still referring to FIG. 2A, an optional coolant supply heater (notshown), thermally coupled to the Cooling Fluid Supply 18 may becontrolled by the MCU 22 according to an authorized algorithm to heatcooling fluid supply 18 so that heated cooling fluid flows through valve32 and through a lumen 34 of a cooling fluid supply tube 36. Supply tube36 is, at least in part, disposed within a closed lumen 38 of probe 26,with the supply tube extending distally from a proximal end 40 of theneedle toward a distal end 42. The exemplary supply tube 36 comprises afused silica tubular structure (not illustrated) having a polymercoating and extending in cantilever into the needle lumen 38. Previouslyincorporated U.S. Patent Publication No. 2008/0200910 disclosesadditional details on the needle 26 along with various alternativeembodiments and principles of operation.

The cooling fluid injected into lumen 38 of needle 26 will typicallycomprise liquid, though some gas may also be injected. At least some ofthe liquid vaporizes within needle 26, and the enthalpy of vaporizationcools the needle and also the surrounding tissue engaged by the needle.The MCU 22 can control the probe heater 44 according to an authorizedtreatment algorithm to heat the proximal region of the needle 26 inorder to prevent unwanted skin damage in this area, as discussed ingreater detail below. Controlling a pressure of the gas/liquid mixturewithin lumen 38 substantially controls the temperature within lumen 38,and hence the treatment temperature range of the tissue. A relativelysimple mechanical pressure relief valve 53 may be used to control thepressure within the lumen of the needle, with the exemplary valvecomprising a valve body such as a ball bearing, urged against a valveseat by a biasing spring. An exemplary relief valve is disclosed in U.S.Provisional Patent Application No. 61/116,050 previously incorporatedherein by reference. Thus, the relief valve allows better temperaturecontrol in the needle, minimizing transient temperatures. Furtherdetails on exhaust volume are disclosed in previously incorporated U.S.Pat. Pub. No. 2008/0200910.

A temperature sensor 52 (e.g., thermistor, thermocouple) can also bethermally coupled to a thermally responsive element 50 that receivesheat from the probe heater 44, and communicatively coupled to the MCU22. The MCU 22 can be configured according to an authorized treatmentalgorithm to receive temperature information of the thermally responsiveelement 50 via the temperature sensor 52 in order to provide the heater44 with enough power to maintain the thermally responsive element 50 ata particular temperature. The probe 26 also includes a secure processorreferred to herein as the disposable secure processor (DSP) 27 thatcommunicates with the MCU 22 and HSP 23.

The MCU 22 can be further configured according to an authorizedtreatment algorithm to monitor power draw from the heater 44 in order tocharacterize tissue type, perform device diagnostics, and/or providefeedback for a tissue treatment algorithm. This can be advantageous overmonitoring temperature since power draw from the heater 44 can varygreatly while temperature of the thermally responsive element 50 remainsrelatively stable.

Alternative methods to inhibit excessively low transient temperatures atthe beginning of a refrigeration cycle may be employed by the MCU 22according to an authorized treatment algorithm, instead of or togetherwith the limiting of the exhaust volume. For example, the supply valvemight be cycled on and off by the MCU 22, with a timing sequence thatwould limit the cooling fluid flowing so that only vaporized gas reachedthe needle lumen (or a sufficiently limited amount of liquid to avoidexcessive dropping of the needle lumen temperature). Analytical modelsthat may be used to estimate cooling flows are described in greaterdetail in U.S. Pub. No. 2008/0154254, previously incorporated byreference. The application of a treatment algorithm may include thecontrol of multiple parameters such as temperature, time, cycling,pulsing, and ramp rates for cooling or thawing of treatment areas. Inparallel with the treatment algorithm, one or more power monitoringalgorithms can be implemented. Examples of such treatment and powermonitoring algorithms are disclosed in U.S. patent application Ser. No.13/741,360, which is incorporated by reference.

FIG. 2B shows a portion of FIG. 2A to illustrate the securitycommunication architecture between the handpiece 16 and the probe 26.The MCU 22 serves as a communications router between the HSP 23 and theDSP 27. The MCU 22 contains software applications code, communicationlinks and related electronic circuitry. The HSP 23 can contain memorywith custom software and configuration data, and may include one or moredigital certificates (e.g., X509 certificates). The probe secureprocessor DSP 27 can also contain memory with custom software and a tipdescriptor, which includes configuration and/or identification data, andin some embodiments can include one or more digital certificates (e.g.,X509 certificates). The tip descriptor can be stored as a binary largeobject (blob) or similar data structure that includes operationalinstructions for the MCU 22. These instructions conform to the type ofprobe 26 being used, since different types of probes (needle count,size, application) require different metering of cryogenic fluid and insome cases heater power. Such instructions can include a predeterminedamount of treatment cycles, treatment cycle parameters, treatmentcontrol parameters, tip identification, probe/handpiece compatibilitysettings and performance test parameters. Accordingly, without this datathe MCU 22 cannot operate the cryogenic system when connected with theprobe 26. This is advantageous, since it can prevent fraudsters fromproducing effective copies since the instructions can be difficult toprocure.

The two secure processors can communicate with one another by way ofelectronic circuitry and software of the MCU 22. Software in the MCU 22and the secure processors implements communication protocols, includingcommand and reply. The software contains logic to perform authentication(e.g., PKI-based) between the disposable probe and reusable patienttreatment devices. This software uses cryptographic techniques toestablish trusted identity and secure communication. Interprocessorcommunication devices and protocols may be used that include, e.g., I2C,SPI, serial, or ISO7816. In some embodiments, the probe 26 and thehandpiece 16 can communicate wirelessly. The use of wirelesscommunication between disposable and durable components may support aproduct architecture where the components are not directly connected.For example, in some cases, the handpiece 16 can rest on a rechargingbase station when not in use, and the HSP 23 may reside within the basestation, while the MCU 22 resides in the handpiece 16. Accordingly, theHSP 23 is not limited to be being physically located within a“handpiece.” In addition, while the term “durable” as used herein iscommonly associated with a handheld device, the term can includehandheld devices dock or other remotely accessed accessories. Thecharging base may in turn serve as a gateway to local and wide-areanetwork services. The services may include customer support, productsecurity, inventory management, treatment monitor, training, and brandextension content.

The probe 26 can be authenticated using PKI signing challenge methods bythe HSP 23. In some embodiments, the DSP can authenticate the HSP. TheDSP 27 may refuse a request to provide the application configurationdata if authentication has not been completed. This feature, optionallyin conjunction with a feature that requires the probe 26 and handpiece16 to use external data for operation, provides a way of denying use ofthe cryogenic system in cases where trust has not been established thatthe probe 26 is authentic and not expired. In some embodiments, the MCU22 can send the request to start a cooling cycle to HSP 23, which thenuses encrypted communications to forward the request to DSP 27 only ifthe one or both of the processors have been authenticated.

The authentication method between the HSP 23 and DSP 27 may includetwo-way authentication. That is, the DSP 27 will require authenticationof the HSP 23 in addition to the HSP 23 requiring authentication of theDSP 27 before allowing further communication or before providing the tipdescriptor. Accordingly, one or more probe components may authenticateone or more handpiece components, in addition to the authenticationprocesses initiated by the one or more handpiece components.

In some embodiments, the authentication method can be extended to covermultiple types of probes (e.g., pain treatment needles, cosmeticneedles, etc.). This design alternative could enforce an electronicmanifest, configured in the disposable device, which would authenticatethe set(s) of disposable devices. For example, if a certain procedurerequired a probe kit for sequential probe use, e.g., a first type ofprobe and a second type of probe (or more) or a plurality of identicalprobes, then the first probe would provide authentication for remainingprobe(s).

In some embodiments, the MCU 22 can connect to a remote authorizationservice. For example the HSP 23 may be located in a remote server thatthe MCU 22 remotely communicates with. In this embodiment the disposabledevice is authenticated remotely. The authenticated disposable devicecan then provide one or more communications channels for one or moredisposable components, which in turn are authenticated. In someembodiments, the HSP 23, or both the HSP 23 and the DSP 27, can requireauthentication by a remote PKI server prior to further operation. Thisauthentication may include comparing the digital certificates stored inthe secure processors to a list of revoked x509 certificates issued by atrusted Certificate Authority. This would allow a remote capability todisable a device.

FIGS. 3A-3C illustrate a logical method 300A of authentication betweenthe HSP 23 and DSP 27, using the MCU 22 as a communications router. FIG.3A is a sequence chart of the method 300A. FIG. 3B primarily shows theauthentication portion of the method 300A by way of a flow diagram,while FIG. 3C includes a post authentication treatment cycle continuingfrom FIG. 3B.

With attention primarily to FIG. 3B, at operation 302 a the MCU 22detects that the probe 26 has been connected to the handpiece 16 andaccordingly initiates a probe connection protocol. Accordingly, atoperation 302 b the MCU 22 sends a request to the HSP 23 to authenticatethe probe 26 and also initiates a first timer to start a predeterminedcount-down to receive a reply from the HSP 23.

At operation 304 a the HSP 23 at operation 304 a receives theauthentication request from the MCU 22, and at operation 304 b issues anauthentication challenge to the DSP 27 and initiates a second timer tostart a predetermined count-down to receive a reply from the DSP 27.This challenge may include requesting a certificate from the DSP 27.

At operation 304 c the DSP 27 receives the authentication challenge fromthe HSP 23. At operation 304 d, the DSP 27 answers the challenge, e.g.,the DSP 27 will return an X.509 compliant certificate.

At operation 304 e the HSP 23 receives the certificate from the DSP 27assuming the second timer has not run out, which would result in aauthentication failure. At operation 304 f the HSP 23 can verify theauthenticity of the certificate using one or more stored digitalcertificates issued by an authorized authority. Non-verification resultsin an authentication failure.

Assuming the certificate is verified, at operation 304 g the HSP 23 cancreate and encrypt a nonce (i.e., number used once) using a public key,and then request the DSP 27 to decrypt the nonce, which can only be doneusing a private key. At operation 304 h the DSP 27 receives thedecryption request and encrypted nonce from the HSP 23. At operation 304i the DSP 27 decrypts the encrypted nonce using the private key from theverified certificate and sends the decrypted nonce back to the HSP 23for verification by the HSP 23 at operation 304 j. If the DSP 27correctly decrypts the encrypted nonce and returns it to the HSP 23, andif the HSP 23 verifies the decrypted nonce against the original withinthe time limit of the second timer, then the tip is authenticated.However, if the DSP 27 does not decrypt the nonce, then the tip is notauthenticated. As a result, at operation 304 k the HSP 23 communicatesthe authentication result (pass/fail) to the MCU 22.

At operation 302 c the MCU 22 determines if the authentication result isreceived within the time limit of the first timer. If the MCU 22 has notreceived a reply within the time limit of the first timer, the processstops. At operation 302 d the MCU 22 determines if the authenticationresult has passed or failed. If authentication fails, the MCU 22 refusesto operate with the probe 26 and the process stops. In either case of atime run-out or authentication failure, the MCU 22 provides an indicator(e.g., flashing light) to the user that the probe 26 is unusable atoperation 302 g. At this point, probe authentication is complete.However, communication between the DSP 27 and MCU 22 and or HSP 23 isstill required for further operation.

If authentication is established, the probe connection detectionprotocol continues at operation 302 e, where the MCU 22 requests systemparameters to operate the probe, i.e., the tip descriptor. Accordingly,the HSP 23 sends an encrypted communication to the DSP 27 requesting thetip descriptor. At operation 306 a the DSP 27 receives the request forthe tip descriptor. At operation 306 b the DSP checks whether theauthentication protocol is completed, if so, the DSP 27 sends the tipdescriptor to the MCU 22 at operation 306 c. If the authenticationprotocol has not been completed, then the DSP 27 sends an error messageto the MCU 22 at operation 306 d. The HSP 23 then decrypts the tipdescriptor for the MCU 22. The MCU 22 can then provide an indicator(e.g., steady light) to the user that the probe is useable.

With attention now primarily to FIGS. 3A and 3C, the method 300Acontinues to operation 308 a in which the MCU 22 is ready to begincoolant flow and/or heater functions according to particularinstructions received in the tip descriptor. These instructions arebased on the particular type of needle configuration and/or intendedtherapy procedure for the probe 26. In some cases, the probe 26 isreusable, but only for a particular number of instances and/or apredetermined amount of time after first use. The DSP 27 is configuredto record historical use using a counter and clock. Hence, at operation308 b the MCU 22 is required to request an initiation signal of thetreatment cycle from the DSP 27, via an encrypted communication by theHSP 23 at operation 310 a. The encrypted communication is send to theDSP 27 at operation 310 b.

At operation 312 a/b the DSP 27 receives and decrypts the request fromthe HSP 23. At operations 312 c the DSP 27 determines whether there aregreater than zero cycles remaining on the counter. If there are cyclesremaining, at operation 312 d the DSP 27 decrements the counter andissues a command to treat. If no cycles remain, then at operation 312 ethe DSP issues a command to halt use. At operation 312 f, the resultingcommand is encrypted by the DSP 27 and sent to the HSP 23, which atoperations 310 c/310 d is decrypted and sent to the HSP 22.

If the count and/or date indicates to the DSP 27 that the probe 26 isexpired, then at operations 314 f/g the MCU 22 can then provide anindicator (e.g., flashing light) to the user that the probe 26 isunusable. Optionally, the MCU 22 may essentially break itself(unrecoverable error) to avoid any attempted fraudulent use, such thatthe MCU 22 can only be used further if reset in a specific manner.Conversely, if the treat command is received, the MCU 22 may begin atreatment cycle, which occurs at operation 314 b. The MCU 22 can thenprovide an indicator (e.g. steady light) to the user that the probe 26is useable. During the treatment cycle, at operation 314 c, the MCU 22fluidly connects the probe 26 to the cooling fluid supply 18 byoperation of the valve 32 and provides power to the heater 44 ifpresent, according to the parameters received in the tip descriptor.

After the treatment cycle is performed, at operation 314 e the MCU 22sends a status indication of the cycle status to the DSP 27 by way ofthe HSP 23, which encrypts and sends the status indication at operations316 a/b. For example, cycle status can indicate whether the cycle wassuccessful or unsuccessful. The cycle status can be decrypted andrecorded by the DSP 27 at operations 318 a/b. Based on this, the DSP 27may prevent future use if the status indicates that the probe 26 isfaulty. Status may also include sensor data useful for troubleshootingprocedure issues.

A mutual authentication method 300B is shown in FIG. 3D and FIG. 3E. Themethod is largely the same as depicted in FIGS. 3A-3C, with the addedprocedure to authenticate the handpiece. Hence, the description aboveapplies to most of FIGS. 3D and 3E.

Upon completion of tip authentication, at operations 320 a to 320 b theMCU 22 may send a message to the DSP 27 requesting that the DSP 27authenticate the handpiece. This may be accomplished by the DSP 27performing a signing challenge with the HSP 23 (i.e., certificateverification and nonce decryption) in operations 320 c to 320 g, asdescribed above. Two-way authentication may also optimize traffic byinterleaving the two authentication sequences. For example, the MCU 22may send authentication requests to the HSP 23 and the DSP 27. Thecertificate request can be accompanied by the challenger's certificate.

FIG. 4 shows a simplified authentication method 400. In someembodiments, secure authorization is not necessary, accordingly, the MCU22 and the DSP 27, which may be a non-secure processor in this case, cancommunicate directly without the need for encryption. At operation 402the handpiece MCU 22 detects connection of the probe, and accordingly atoperation 404 sends a request for a tip descriptor and optionallyinitiates a timer.

At operation 406 the DSP 27 receives the request for the tip descriptor.The DSP 27 may optionally check if any cycles remain for use and if sodecrement a counter at operation 408. At operation 410 the DSP 27 sendsthe tip descriptor or expiration indicator back to the MCU 22, whichdetermines at operation 212 if a reply has been received. At operation414, the MCU 22 determines if the timer stopped, and if so halts use atoperation 418. If the timer has not stopped, then at operation 416, theMCU 22 determines if the tip descriptor or optionally an expirationindicator was received, which in the case of the latter causes the MCUto halt use. At operation 420 the MCU 22 can optionally retrievetreatment parameters from memory based on information received in thetip descriptor, otherwise, all treatment parameters are received in thetip descriptor and probe is ready for use.

While the exemplary embodiments have been described in some detail forclarity of understanding and by way of example, a number ofmodifications, changes, and adaptations may be implemented and/or willbe obvious to those as skilled in the art. Hence, the scope of thepresent invention is limited solely by the claims as follows.

What is claimed is:
 1. A cryogenic probe comprising: a body releasablycouplable to a handpiece and having at least one cryogenic treatmentapplicator fluidly connectable to a separate coolant supply device forproviding coolant to the at least one cryogenic treatment applicator byway of a controllable valve; and an integrated circuit having a firstprocessor and storing a tip descriptor, the integrated circuit beingdisposed within the body of the cryogenic probe, wherein the tipdescriptor comprises operating instructions to control metering of thecoolant to the cryogenic treatment applicator and wherein the integratedcircuit is configured to send the tip descriptor including the operatinginstructions to control metering of the coolant to a second processordisposed in the handpiece for execution by the second processor.
 2. Thecryogenic probe of claim 1, wherein the integrated circuit is configuredto send the tip descriptor including the operating instructions tocontrol metering of the coolant to the second processor disposed in thehandpiece for execution by the second processor in response to a requestfrom the second processor and wherein the second processor initiates atimer for response by the integrated circuit to the request.
 3. Thecryogenic probe of claim 1, wherein the integrated circuit comprisesmemory for storing the tip descriptor.
 4. The cryogenic probe of claim1, wherein the operating instructions comprise a protocol for timingopening and closing of the controllable valve.
 5. The cryogenic probe ofclaim 1, wherein the body comprises a heater and wherein the tipdescriptor includes heater control parameters.
 6. The cryogenic probe ofclaim 5, wherein the tip descriptor includes a target heatertemperature.
 7. The cryogenic probe of claim 1, wherein the tipdescriptor includes test parameters.
 8. The cryogenic probe of claim 1,wherein the tip descriptor includes expiration information.
 9. Thecryogenic probe of claim 1, wherein the operating instructions compriseinstructional parameters for operating the separate coolant supplydevice.
 10. The cryogenic probe of claim 1, wherein the at least onecryogenic treatment applicator comprises a sharpened or blunted needle.11. The cryogenic probe of claim 1, wherein the first processor is asecure processor.
 12. The cryogenic probe of claim 1, further comprisinga microprocessor control unit including the second processor disposed inthe handpiece.
 13. The cryogenic probe of claim 12, wherein the firstprocessor and a third processor disposed in the handpiece communicatevia the microprocessor control unit.
 14. The cryogenic probe of claim13, wherein the first processor and third processor are secureprocessors and wherein the third processor is configured to authenticatethe first processor by issuing an authentication challenge to the firstprocessor and assessing a response from the first processor to determineauthenticity of the first processor.
 15. The cryogenic probe of claim14, wherein the first processor is configured to authenticate the thirdprocessor by issuing an authentication challenge to the third processorand assessing a response from the third processor to determine theauthenticity of the third processor.
 16. A kit of cryogenic probescomprising: a plurality of cryogenic probes, each cryogenic probereleasably couplable to a handpiece and having a body with at least onecryogenic treatment applicator fluidly connectable to a separate coolantsupply device for providing coolant to the at least one cryogenictreatment applicator, wherein at least one of the cryogenic probesincludes a first processor comprising memory having instructionalparameters for operating the coolant supply device and configured tosend the instructional parameters to a second processor disposed in thehandpiece for execution by the second processor, and wherein the firstprocessor is configured to send the instructional parameters in responseto a request from the second processor, and wherein the second processorinitiates a timer for response by the first processor to the request.17. The kit of cryogenic probes of claim 16, wherein the handpiececomprises a microprocessor control unit configured to serve as acommunications router between the first processor and a third processordisposed in the handpiece.
 18. A system for cryogenically treatingtissue, the system comprising: a first type of probe having a firstprocessor and memory storing a first type of tip descriptor, the firsttype of probe having at least one cryogenic treatment applicator; and ahandpiece having a microprocessor control unit (MCU), the handpiecebeing releasably couplable and compatible with a plurality of differenttypes of probes, wherein the first type of probe is fluidly couplable toa closed coolant supply system within the handpiece, wherein the firstprocessor is configured to communicate the first type of tip descriptorto the MCU, wherein the MCU is configured to provide a first indicatorwhen the first type of probe is usable and a second indicator differentfrom the first indicator when the first type of probe is unusable, andwherein the MCU is configured to implement a first type of treatmentprotocol based on the first type of tip descriptor when the first probeis usable.
 19. The system of claim 18, wherein the first type oftreatment protocol is provided by the first type of tip descriptor andcomprises operating instructions to control metering of coolant from thecoolant supply system to the at least one cryogenic treatmentapplicator, and wherein the first processor is configured to send thefirst type of tip descriptor including the operating instructions to theMCU for execution by the MCU.
 20. The system of claim 18, wherein thefirst type of treatment protocol is retrieved from memory of the firsttype of probe by the MCU.
 21. The system of claim 18, wherein the firsttype of indicator comprises a steady light and the second type ofindicator comprises a flashing light.
 22. The system of claim 18,wherein the microprocessor control unit serves as a communicationsrouter between the first processor and a second processor.
 23. Thesystem of claim 22, wherein the second processor is configured toauthenticate the first processor by issuing an authentication challengeto the first processor and assessing a response from the first processorto determine authenticity of the first processor.
 24. The system ofclaim 23, wherein the first processor is configured to authenticate thesecond processor by issuing an authentication challenge to the secondprocessor and assessing a response from the second processor todetermine the authenticity of the second processor.